Individual
FRANK A BOUTIETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2751 COMMERCIAL BLVD STE 5, LAKE HALLIE, WI 54729-5080
(800) 974-4378
(630) 515-1536
Mailing address
24014 W RENWICK RD UNIT 206, PLAINFIELD, IL 60544-8711
(800) 974-4378
(630) 515-1536
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3524-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40183700
—
WI
Enumeration date
03/08/2007
Last updated
10/06/2024
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